My Draining Brain

Week 4 and 5

Over the past month I have seen variety of cases, infectious and non infectious disease. Malaria is endemic in the surrounding area. RVI/OI is the commonest cause of in hospital admission and death. Cardiovascular disease is on the rise due to sedentary life style in the cities. Below are few of the interesting and sad cases I saw in my 4th and 5th week here in Adama;

1. 32 years old female admitted with LOC 24 hours after given birth. Delivery was at home, she had witnessed seizure by family member while giving birth. presented to ED with LOC. GCS of 4/15. BP 210/120. Admitted to ICU with working dx of eclampsia and now fighting for her life. concern for intracranial hemorrhage..imaging is not available in the hospital. Heartbreaking to see a mother die from pregnancy and child birth related complication

2. 25 years old female came in encephalophatic, foaming and hydrophobic...
Hx: 20 days a go she got bitten by a street dog on the neck... Rabies is under reported killer in east Africa. Main victims are women and kids beaten by street dogs. Rabies immune globulin is not available in the country. There is no national vaccine program. The community usually kills street doges by stoning or shooting them.

3. 36 years old male Recent DX of RVI at a health care center/base line CD4 not available to us came with headache which started a week after starting ART. Head MRI shown below. V/s stable, no latralizing sign on exam. DDx Toxo, creptoccocoma, Tuberculoma, PML... not settled yet.

cephalic tetanus from a head wound

another tetanus case from a nail foot injury

4. 19 years old male came with cranial nerve disfunction and ultimately developed generalized tetanus. He is being managed in a dark room along with one another patient. His frequency of spasms has reduced from 20 to 1 per day now, has been getting diazepam and CPZ. His laryngeal spasm was minimal and did not require tracheotomy!! Will be discharging soon. Tetanus is another common preventable cause of death in Ethiopia